Adolescent Gambling and Problem Gambling: Does the Total Consumption Model Apply?

Skill-Based Electronic Gaming Machines: Features that Mimic Video Gaming, Features that could Contribute to Harm, and Their Potential Attraction to Different Groups

New gambling products have been developed over time as technology permits. For example, early mechanical slot machines were later replaced by electronic gaming machines (EGMs), which enabled a faster speed of play and more immersive experience. EGMs have in the decades since their invention become one of the main drivers of gambling expenditure worldwide and are one of the gambling products most strongly associated with harm. This literature review considers research relevant to a new subcategory of EGM, 'skill-based' EGMs, termed 'SGMs' here. SGMs can be highly varied in content, with some representing a minimal departure from EGMs, where the typical bonus round is replaced by some skill-based activity, such as a simple video game, which could increase the machine's appeal. Other SGMs feature more radical departures from conventional EGMs, such as multiplayer games using intellectual property from popular TV shows or video games. These skill-based elements could tap into common gambling fallacies such as the illusion of control, and therefore facilitate harmful engagement. SGMs could also be less harmful than current EGMs, if skill-based elements break the dissociative states associated with EGM gambling. The intellectual property used in SGMs may increase their appeal among people who generally do not gamble, and the skill-based elements could increase their interest among gamblers who predominately prefer skill-based gambling formats such as sports betting. The novelty and varied content of SGMs present many open questions, which research should aim to address in future.

A Systematic Review on Intervention Treatment in Pathological Gambling

Over the last century, there has been a growing interest in researching pathological gambling, particularly in industrialized nations. Historically, gambling was widely perceived as morally questionable, condemned by religious groups. However, contemporary concerns have shifted towards the health repercussions of gambling disorders and broader societal impacts like increased crime and money laundering. Governments, aiming to mitigate social harm, often regulate or directly oversee gambling activities. The global surge in legal gambling has resulted in a substantial rise in its prevalence, popularity, and accessibility in the last two decades. This paper provides a comprehensive overview of global research on interventions for pathological gambling. Through a systematic search on platforms such as EBSCO, PubMed, and Web of Science, 13 relevant records were identified. The revised findings indicate a heightened occurrence of behavioral addictions, linking them to the early onset of gambling issues and their severe consequences. The research emphasizes the active role that clients play in the process of self-directed change and therapy. Therapists recognizing clients as both catalysts for change and potential obstacles can enhance their effectiveness. A common source of resistance arises when clients and therapists are in different stages of the change process, underlining the importance of therapists aligning with clients' readiness for change. Recognizing the urgent need for a better understanding of this problem in adolescents, this study emphasizes the necessity to tailor prevention and treatment plans based on gender and age-specific requirements.

"Show Me the Money": Preliminary Lessons from an Implementation of Intervention Tools at the Payment Gateway Level

Traditional approaches that seek to study Responsible Gambling (RG) mainly focus on evaluating platform-based intervention tools applied on gambling operator sites. This paper reports on the implementation, at the payment-solution level, of an intervention tool that gambling customers used to deposit their bets. The approach pre-commits customers to set a single-point spending limit on their payment gateway account, effectively enabling them to apply their budget setting on all gambling platforms on which they choose to play. Ten users who have used the provision for at least six months and on two different gambling platforms were selected for an in-depth interview. Based on the findings from content analysis, the article argues that payment-level intervention approach can potentially (1) provide the overall gambling population with better financial literacy regarding their gambling habits, which promotes responsible spending behaviour, (2) elevate the strain on users to set up intervention tools on every individual platform, and (3) serve as a preventive measure regardless of the existence or absence of intervention tools at gambling sites. Furthermore, the results affirm a gap in existing research and a need for comprehensive guidelines and strategies for financial institutions to positively contribute towards the agenda of RG. The findings of this study highlight the need for revisiting theoretical and philosophical foundations of intervention tool studies and gambling policymaking as well as calls for reassessing how we problematised harmful gambling. The paper contributes to the research on gambling intervention tools.

Setting Limits: Gambling, Science and Public Policy-summary of results

The gambling industry has grown into a global business in the 21st century. This has created the need for a new emphasis on problem prevention. This article highlights the core themes of the book Setting Limits: Gambling, Science and Public Policy, taking a broad view of the consequences of gambling for society as a burden on health, well-being and equality. The book covers the extent of gambling and gambling-related problems in different societies and presents a critical review of research on industry practices, policy objectives and preventive approaches, including services to people suffering from gambling and its consequences. It discusses the developments in game characteristics and gambling environments and provides evidence on how regulation can affect those. Effective measures to minimize gambling harm exist and many are well supported by scientific evidence. They include restrictions on general availability as well as selective measures to prevent gamblers from overspending. The revenue generated from gambling for the industry, governments, and providers of public services funded from gambling returns presents an obstacle to developing policies to implement harm-reduction measures. A public interest approach must weigh these interests against the suffering and losses of the victims of gambling.

Adolescent Gambling, Gambling Expenditure and Gambling-Related Harms in Finland, 2011-2017

Existing literature on recent trends in adolescent gambling is scarce. The rapidly changing landscape of gambling, together with the generally applied legal age limits, calls for the continuous monitoring of gambling also among the adolescent population. In Finland, the legal gambling age is 18. We examined changes in adolescents’ gambling, gambling expenditure and gambling–related harms from 2011 to 2017. Comparable cross-sectional biennial survey data were collected in 2011, 2013, 2015 and 2017 among 12–18-year-olds (N = 18,857). The main measures were self-reported six-month gambling, average weekly gambling expenditure (€) and harms due to gambling. Data were analyzed using cross-tabulations, χ²-tests and linear regression analysis. A significant decline in gambling among minors (aged 12–16-year-olds) was found (β = − 0.253), while no significant changes were observed among 18-year-olds (who are not targeted by the law). The mean gambling expenditure also declined from 2011 to 2017. Adolescent gamblers experienced significantly less (p = .003) gambling–related harms in 2017 (7.4%) compared to 2011 (13.5%). Adolescent gambling and its related negative consequences have become less prevalent in Finland between 2011 and 2017. Further monitoring is necessary to ascertain whether the positive direction will continue. Also, empirical analyses providing evidence of reasons for the observed trend are warranted.

Online Survey of Gambling Participation and Problem Gambling in Chiba City: Problem Gambling Rates May be Strongly Influenced by the Administration Mode

Prevalence studies on gambling participation and problem gambling in Japan have been limited. To obtain data showing the current status of gambling in Japan, we conducted an online survey on gambling participation and problem gambling among residents in Chiba City. The online data collection was conducted through an Internet research firm. Questionnaires were consisted of personal demographics, past-year gambling participation and severity of gambling risks. The Problem Gambling Severity Index (PGSI) was used as a survey instrument. Males (51.5%) were significantly more likely than females (25.5%) to have gambled in the past year. Problem gamblers (PGSI score ≧ 8) were 7.2% among males and 1.2% among females. Problem gambling was strongly correlated with frequent gambling, preference for Pachinko/Slot and smoking habit. The gambling participation rates were roughly lower than those reported in many overseas jurisdictions, whereas the problem gambling rates were considerably higher than those reported in the same jurisdictions. According to the total consumption model, it would be reasonable to consider that gambling participation rates show a positive correlation with problem gambling rates. The high levels of problem gambling may be due to the administration mode using online sampling, by which answers admitting unapprovable behaviors like problem gambling tend to increase. This suggests that the previous studies using conventional face-to-face or telephone methods may have underestimated problem gambling rates.

The total consumption model applied to gambling: Empirical validity and implications for gambling policy

Aim:

The total consumption model (TCM) originates from studies of the distribution of alcohol consumption and posits that there is a strong association between the total consumption and the prevalence of excessive/harmful consumption in a population. The policy implication of the TCM is that policy measures which effectively lead to a reduction of the total consumption, will most likely also reduce the extent of harmful consumption and related harms. Problem gambling constitutes a public health issue and more insight into problem gambling at the societal level and a better understanding of how public policies may impact on the harm level, are strongly needed. The aim of this study was to review the literature pertaining to empirical validity of the TCM with regard to gambling behaviour and problem gambling and, on the basis of the literature review, to discuss the policy implications of the TCM.

Methods:

The study is based on a literature mapping through systematic searches in literature databases, and forward and backward reference searches.

Results:

The literature searches identified a total of 12 empirical studies that examined the total consumption model or provided relevant data. All but one of these studies found empirical support for the TCM; that is, a positive association between population gambling mean and prevalence of excessive or problem gambling. Such associations were found both with cross-sectional data and with longitudinal data.

Conclusion:

There is a small but fairly consistent literature lending empirical support to the total consumption model. An important policy implication is that interventions which are successful in reducing overall gambling are likely also to reduce problem gambling incidence.

The relationship between gambling expenditure, socio-demographics, health-related correlates and gambling behaviour-a cross-sectional population-based survey in Finland

AIMS

To investigate gambling expenditure and its relationship with socio-demographics, health-related correlates and past-year gambling behaviour.

DESIGN

Cross-sectional population survey.

SETTING

Population-based survey in Finland.

PARTICIPANTS

Finnish people aged 15-74 years drawn randomly from the Population Information System. The participants in this study were past-year gamblers with gambling expenditure data available (n = 3251, 1418 women and 1833 men).

MEASUREMENTS

Expenditure shares, means of weekly gambling expenditure (WGE, €) and monthly gambling expenditure as a percentage of net income (MGE/NI, %) were calculated. The correlates used were perceived health, smoking, mental health [Mental Health Inventory (MHI)-5], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)-C], game types, gambling frequency, gambling mode and gambling severity [South Oaks Gambling Screen (SOGS)].

FINDINGS

Gender (men versus women) was found to be associated significantly with gambling expenditure, with exp(β) = 1.40, 95% confidence interval (CI) = 1.29, 1.52 and P < 0.005 for WGE, and exp(β) = 1.39, 95% CI = 1.27, 1.51 and P < 0.005 for MGE/NI. All gambling behaviour correlates were associated significantly with WGE and MGE/NI: gambling frequency (several times a week versus once a month/less than monthly, exp(β) = 30.75, 95% CI = 26.89, 35.17 and P < 0.005 for WGE, and exp(β) = 31.43, 95% CI = 27.41, 36.03 and P < 0.005 for MGE/NI), gambling severity (probable pathological gamblers versus non-problem gamblers, exp(β) = 2.83, 95% CI = 2.12, 3.77 and P < 0.005 for WGE, and exp(β) = 2.67, 95% CI = 2.00, 3.57 and P < 0.005 for MGE/NI) and on-line gambling (on-line and land-based versus land-based only, exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for WGE, and exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for MGE/NI).

CONCLUSIONS

In Finland, male gender is associated significantly with both weekly gambling expenditure and monthly gambling expenditure related to net income. People in Finland with lower incomes contribute proportionally more of their income to gambling compared with middle- and high-income groups.

A meta-regression analysis of 41 Australian problem gambling prevalence estimates and their relationship to total spending on electronic gaming machines

BACKGROUND

Many jurisdictions regularly conduct surveys to estimate the prevalence of problem gambling in their adult populations. However, the comparison of such estimates is problematic due to methodological variations between studies. Total consumption theory suggests that an association between mean electronic gaming machine (EGM) and casino gambling losses and problem gambling prevalence estimates may exist. If this is the case, then changes in EGM losses may be used as a proxy indicator for changes in problem gambling prevalence. To test for this association this study examines the relationship between aggregated losses on electronic gaming machines (EGMs) and problem gambling prevalence estimates for Australian states and territories between 1994 and 2016.

METHODS

A Bayesian meta-regression analysis of 41 cross-sectional problem gambling prevalence estimates was undertaken using EGM gambling losses, year of survey and methodological variations as predictor variables. General population studies of adults in Australian states and territory published before 1 July 2016 were considered in scope. 41 studies were identified, with a total of 267,367 participants. Problem gambling prevalence, moderate-risk problem gambling prevalence, problem gambling screen, administration mode and frequency threshold were extracted from surveys. Administrative data on EGM and casino gambling loss data were extracted from government reports and expressed as the proportion of household disposable income lost.

RESULTS

Money lost on EGMs is correlated with problem gambling prevalence. An increase of 1% of household disposable income lost on EGMs and in casinos was associated with problem gambling prevalence estimates that were 1.33 times higher [95% credible interval 1.04, 1.71]. There was no clear association between EGM losses and moderate-risk problem gambling prevalence estimates. Moderate-risk problem gambling prevalence estimates were not explained by the models (I ² ≥ 0.97; R ² ≤ 0.01).

CONCLUSIONS

The present study adds to the weight of evidence that EGM losses are associated with the prevalence of problem gambling. No patterns were evident among moderate-risk problem gambling prevalence estimates, suggesting that this measure is either subject to pronounced measurement error or lacks construct validity. The high degree of residual heterogeneity raises questions about the validity of comparing problem gambling prevalence estimates, even after adjusting for methodological variations between studies.

Improving spatial microsimulation estimates of health outcomes by including geographic indicators of health behaviour: The example of problem gambling

Gambling is an important public health issue, with recent estimates ranking it as the third largest contributor of disability adjusted life years lost to ill-health. However, no studies to date have estimated the spatial distribution of gambling-related harm in small areas on the basis of surveys of problem gambling. This study extends spatial microsimulation approaches to include a spatially-referenced measure of health behaviour as a constraint variable in order to better estimate the spatial distribution of problem gambling. Specifically, this study allocates georeferenced electronic gaming machine expenditure data to small residential areas using a Huff model. This study demonstrates how the incorporation of auxiliary spatial data on health behaviours such as gambling expenditure can improve spatial microsimulation estimates of health outcomes like problem gambling.

Changes in youth gambling after the removal of slot machines in Norway

Aims

To examine whether the ban and complete removal of slot machines in Norway in 2007 may have led to: a) changes in gambling behaviour and changes in prevalence of problem gambling among adolescents, and b) changes in gambling behaviour among adolescent problem gamblers.

Data & Methods

Two school surveys were conducted, one before (in 2006) and one after the intervention (in 2008), comprising students aged 13 to 18 years (net samples = 4,912 in 2006 and 3,855 in 2008). Identical measures of gambling behaviour and problem gambling were obtained in both surveys.

Results

After the intervention, a small proportion reported that they had changed their gambling behaviour, mainly in terms of having stopped gambling. Comparisons of self-reports of gambling behaviour showed that slot machine gambling had decreased significantly, while gambling on other games had increased, yet frequent gambling on any game had decreased after the intervention. However, the change in prevalence of at-risk and problem gambling differed across instruments. The prevalence of self-perceived gambling problems had decreased whereas the prevalence of at-risk and problem gambling as assessed by SOGS-RA had increased. Among at-risk and problem gamblers frequent gambling and perceived gambling problems were reported less frequently in 2008 compared to 2006.

Conclusion

The ban and removal of slot machines in Norway was succeeded by a decrease in frequent gambling among adolescents in general as well as among at-risk and problem gamblers.

Changes in Minors' Gambling on Slot Machines in Finland after the Raising of the Minimum Legal Gambling Age from 15 to 18 Years: A Repeated Cross-Sectional Study

Aim

The legal gambling age in Finland was raised from 15 to 18 years in 2010, but slot machines were given a transition period that ended with the full law coming into effect on 1 July 2011. The widespread accessibility of slot machines and their popularity among youth led us to consider how age limit was enforced in the Finnish gambling monopoly system and to analyse how underage gambling on slot machines changed after the raising of the minimum age.

Methods

Two nationwide cross-sectional surveys were conducted in 2011 and 2013 (12–18-year-olds; N=8101; average response rate 42%). The main measure was self-reported six-month prevalence of slot machine use overall and by venue (shops; kiosks; petrol stations; restaurants/cafés; ship travels to Sweden/Estonia; other). Changes from 2011 to 2013 were tested by using the χ2 tests and multivariate logistic regression analyses. As a reference group only, 18-year-olds were analysed, as they were of legal age to gamble.

Results

The six-month prevalence of slot machine use among 12–16-year-olds declined from 44% in 2011 to 13% in 2013 (p <.001). The decline was the most pronounced in shops. A significant interaction was found between age and survey year; slot machine use declined more sharply among 16-year-olds than among those aged 14 or 12.

Conclusions

These findings suggest that raising the legal age limit from 15 to 18 years significantly decreased the prevalence of slot machine use among minors, even in a policy context where the general availability of gambling products was not reduced.

Gambling among adolescents with and without hearing loss

OBJECTIVES

This exploratory study investigates the prevalence of gambling, preferred types of gambling, and problem gambling in Swedish young people aged 15-18 years with and without hearing loss.

METHODS

A cross-sectional health survey was conducted in Örebro County, Sweden in 2014. A standardized questionnaire was distributed to 4888 students, and 4329 filled it. There were 318 (8 %) students with hearing loss. The response rate was 82 %. The 2-item Lie/Bet questionnaire (Johnson et al. in Psychol Rep 80:83-88, 1997) was used for measuring problem gambling.

RESULTS

More students with hearing loss had gambled during their lifetime (35 %) and in the past year (25 %) than their hearing counterparts (lifetime: 24 %; past-year: 19 %). More students with hearing loss compared to normal hearing students were identified as problem gamblers (7.7 % compared to 4.3 %).

CONCLUSION

More research is needed on gambling among people with hearing loss as well as other disabilities.

From Boredom to Dependence: The Medicalisation of the Swedish Gambling Problem

Aims

The aim of this study is to investigate the medicalising of gambling problems by comparing the political discussions on gambling in the Swedish Parliament in the early 1970s and the early 2010s.

Design

Against a theoretical background on medicalising processes in general, and medicalisation of gambling problems in particular, we have analysed discussion protocols and parliamentary bills in the Swedish Parliament from the years 1970–1975 and 2012–2013.

Results

The problem descriptions of the 1970s and 2010s are, in certain respects, strikingly similar, identifying proactive operators such as the gambling companies and highlighting an inadequate legal framework. But where the MPs of the 1970s put some effort into describing the drab society which fed the need for gambling, the elected representatives of the 2010s shortcut to individual dependence.

Conclusions

EU membership and the development of the Internet have made effective control and regulation impossible in the early 2010s and the political handling of the Swedish gambling problem is therefore a clear example of how market liberalisation can pave the way for individualisation, medicalisation and depoliticisation of social problems.

How much gambling is too much? Identifying potential problem gambling among adolescents

AIMS

Using a population-based sample of Finnish 12-17 year olds, this study explored gambling behaviour limits for potential problem gambling [South Oaks Gambling Screen - revised for adolescents (SOGS-RA)].

METHODS

Data were obtained from the Youth Gambling Survey 2006, which is a cross-sectional survey of a nationally representative random sample of 5000 adolescents. Adolescents who participated in gambling at least once a month were selected from the data (n=1827, 25.1% were girls). The limits for gambling behaviour were detected using receiver operating characteristic (ROC) analysis. Logistic regression was used to study associations between these behavioural limits and potential problem gambling.

RESULTS

For each of the gambling behaviour indicators plotted, the risk curves showed similar trends among boys and girls. The risk of being a potential problem gambler increased noticeably with increasing gambling intensity. The ROC analysis showed that the optimal behavioural cut-off values among 12-14 year olds for frequency was gambling more than 2-3 times a month, spending more than €2 per week on gambling, spending more than €8 in any 1 day on gambling, and gambling on more than two different games per year. For 15-17 year olds, cut-off values were gambling more than once a week, spending more than €4 per week and spending more than €12 in any 1 day on gambling. Cut-off for number of game types was same as it was for younger adolescents. Of the behavioural indicators those associated with money were the most robust.

CONCLUSION

Behavioural indicators can be used as initial markers of possible problem gambling.

Gambling and Problem Behavior Among 14- to 16-Year-Old Boys and Girls in Finland

The aim of this study is to examine the associations between problem behavior and gambling frequency among eighth- and ninth-grade boys and girls (N = 101,167). Data were obtained from the cross-sectional School Health Promotion Study. Outcome measures were adolescents' truancy, bullying, delinquency, and substance use. Polychotomous logistic regression analyses were used to study the relationship between gambling frequency and risk behaviors in a total sample, as well as separately for boys and girls. In 2010, 62% of the adolescents had gambled during the previous year, and in 2011, 61% of the adolescents had done so. Engaging in different levels of truancy, bullying, delinquency, and substance abuse were associated with higher risks for frequent gambling. Similar patterns of associations were found among boys and girls. Adolescents who engaged in gambling on a daily or weekly basis were the most vulnerable group for problem behavior. However, even infrequent gambling was associated with different problem behaviors.

Internet gambling in problem gambling college students

Internet gambling is popular in college students and associated with problem gambling behaviors. This study evaluated Internet gambling in 117 students participating in study evaluating brief interventions to reduce gambling; the brief interventions consisted of minimal advice, motivational enhancement therapy, and cognitive-behavioral therapy (1-4 sessions). Compared to their counterparts who did not gamble via the Internet (n = 60), those who reported recent Internet gambling (n = 57) wagered in greater frequencies and amounts and reported missing school more often and more problems with family and anxiety due to gambling. Recent Internet gamblers demonstrated similar reductions in gambling over time and in response to the brief interventions as non-Internet gamblers. These data suggest that Internet gambling is common in problem gambling college students, and students who wager over the Internet can benefit from brief interventions.

Pathological gambling and treatment outcomes for adults age 50 or older in methadone maintenance treatment

This study examined the relationship of pathological gambling to negative treatment outcomes for methadone maintenance patients aged 50 or older. The study included 130 methadone maintenance patients. Pathological gambling was determined using the Lie-Bet, a screen for pathological gambling; the outcomes were remaining in treatment and negative urine screens for drug use. Twenty percent of the sample identified as pathological gamblers. Pathological gambling was unrelated to remaining in treatment or negative urine screens. Although pathological gambling had no adverse influence on these treatment outcomes, the prevalence of pathological gambling suggests that screening for it may provide insights about other concerns.

Gambling expenditure predicts harm: evidence from a venue-level study

BACKGROUND AND AIMS

The Total Consumption Theory of gambling suggests that gambling expenditure is positively associated with gambling-related harm. We test the hypothesis that electronic gaming machine (EGM) expenditure predicts gambling-related harm at the level of the EGM venue.

DESIGN

Cross-sectional analysis of survey and administrative data.

SETTING

General urban adult population of the Northern Territory of Australia.

PARTICIPANTS

The sample consisted of 7049 respondents to a mail-survey about venue visitation and gambling behaviour across 62 EGM venues.

MEASUREMENTS

Gambling-related harm was defined as the endorsement of two or more items on the Problem Gambling Severity Index. We obtained venue-level EGM expenditure data from the local licensing authority for all venues in the study area. We compared the prevalence of gambling-related harm among patrons aggregated at the venue level with the estimated mean EGM expenditure for each adult resident in the venue's service area using a Huff model, correlation analysis and multivariate binomial regression.

FINDINGS

Aggregated to the venue level (n = 62), per-capita EGM expenditure was correlated significantly with rates of gambling-related harm (r = 0.27, n = 62, P = 0.03). After adjusting for venue type and number of EGMs, an increase in mean per-capita monthly EGM expenditure from $AU10 to $AU150 was associated with a doubling in the prevalence of gambling-related harm from 9% (95% CI = 6-12%) to 18% (95% CI = 13-23%).

CONCLUSIONS

As suggested by the Total Consumption Theory of gambling, aggregate patron electronic gaming machine expenditure predicts the prevalence of gambling-related harm at the venue level.

After the ban of slot machines in Norway: a new group of treatment-seeking pathological gamblers?

Changes in demographical and clinical features of treatment-seeking pathological gamblers, and their gambling preferences before and after the ban of slot machines in Norway from 1 July 2007. Is there an emergence of a new group of gamblers seeking treatment after the ban? The participants were 99 patients, 16 women and 83 men, with the mean age of 35 years. All were referred to the Bergen Clinics Foundation, Norway, for treatment of gambling addiction in the period October 2006 to October 2009. A comprehensive assessment package was applied, focusing on demographical characteristics, the severity of pathological gambling, mental health and substance use disorder. After the ban the mean age was significantly lower, and significantly more were highly educated, in regular employment, and married. Internet gambling and a sport betting game called Odds were the most common options, and gambling problems had become more severe with greater depth due to gambling, bad conscious, heavy alcohol consumption, and more suicidal thoughts and attempts. After the ban of slot machines, the characteristics of treatment-seeking gamblers have been changed, and with great implications for treatment strategies.

Gambling and problem gambling among young adolescents in Great Britain

International evidence suggests that problem gambling tends to be 2-4 times higher among adolescents as among adults and this proves to be true of Great Britain according to the latest adolescent prevalence survey. 8,958 British children (11-15) were surveyed in 201 schools during late 2008 and 2009. The questionnaire included a standard screen, DSM-IV-MR-J, to test for problem gambling. Our regression models explore influences of demographic, home and school characteristics on probabilities (both unconditional and conditional on being a gambler) of a child testing positive for problem gambling. More than 20% of children participated in gambling and, of these, nearly 8% tested positive. Age-group prevalence of problem gambling was 1.9%, compared with 0.6-0.9% in the most recent official adult surveys. Boys were much more likely than girls to gamble and to exhibit symptoms of problem gambling if they did. Generally, home characteristics, particularly parental attitude and example, dominated school characteristics in accounting for risks. Unanticipated findings included significantly elevated probabilities of problem gambling among Asian children and among children who live in a home without siblings. Child income was also a potent predictor of gambling and problem gambling.

The collectivity of drinking cultures: is the theory applicable to African settings?

AIMS

Skog's theory of collective drinking behaviour implies that countries with a strict informal social control of drinking alcohol would not exhibit 'collective displacement' of consumption (a linear association between population mean consumption and percentile values across the full range of the distribution), as do countries with less informal social control. This paper aimed to test this hypothesis by examining the alcohol consumption distributions in African countries with a strong informal control of alcohol.

DESIGN SETTING, PARTICIPANTS AND MEASUREMENTS

Data on alcohol consumption from the World Health Organization's general population surveys in 15 African countries were aggregated and analysed with respect to skewedness and collective displacement of the distribution.

FINDINGS

The distribution of consumption was strongly positively skewed, with 10-15% of the drinkers consuming more than twice the mean consumption. There was also clear evidence of a collective displacement of the consumption distribution, and the consumption mean was a strong predictor of the distribution percentile values across the full range of the distribution. Correspondingly, consumption mean predicted the prevalence of heavy drinkers.

CONCLUSION

The distribution patterns of alcohol consumption in African countries are consistent with those observed previously in industrialized countries. These findings seem to counter Skog's theory of collective drinking behaviour and support the universality of the observation that the prevalence of problem drinking is linked closely to mean consumption.

Validation of the Consumption Screen for Problem Gambling (CSPG)

A 3 item screen for problem gambling was developed based on a conceptual analogue of the Alcohol Use Disorders Identification Test--Consumption (Bush et al. in Arch Intern Med 158:1789-1795, 1998); a brief screen that measures consumption rather than harm. Data were collected from an email panel survey of 588 men and 810 women (n = 1,398) across all states in Australia. Respondents indicated their consumption of gambling products using the 3 items of the new Consumption Screen for Problem Gambling (CSPG). Receiver Operating Characteristics curve analysis was used to analyze the performance of the new items relative to the Problem Gambling Severity Index (Ferris and Wynne in The Canadian problem gambling index: Final report, 2001). Results show a 98% probability that the CSPG score for a randomly chosen positive case of problem gambling will exceed the score for a randomly chosen negative case. In addition, a score of 4+ on the CSPG identified all 14 cases of Problem Gambling correctly, while only 7.3% of non-problem gamblers had scores of 4+ (sensitivity = 100%; specificity = 92.7%). Lastly, only 3.0% of respondents without any gambling problems had CSPG scores of 4+. The current study suggests that the CSPG, a brief consumption-based measure for gambling products, can quickly and accurately identify people who are likely to be experiencing gambling problems.

The role of alprazolam for the treatment of panic disorder in Australia

OBJECTIVE

To investigate the potential impact of increasing prescription rates of alprazolam for the treatment of panic disorder (PD) in Australia through a review of efficacy, tolerability and adverse outcome literature.

METHODS

Data were sourced by a literature search using MEDLINE, Embase, PsycINFO and a manual search of scientific journals to identify relevant articles. Clinical practice guidelines from the American Psychiatric Association, National Institute of Clinical Excellence, Royal Australian and New Zealand College of Psychiatrists and World Federation of Societies of Biological Psychiatry were sourced. Prescription data were sourced from Australian governmental sources.

RESULTS

Alprazolam has shown efficacy for control of PD symptoms, particularly in short-term controlled clinical trials, but is no longer recommended as a first-line pharmacological treatment due to concerns about the risks of developing tolerance, dependence and abuse potential. Almost no evidence is available comparing alprazolam to current first-line pharmacological treatment. Despite this, prescription rates are increasing. A number of potential issues including use in overdose and impact on car accidents are noted. conclusion: Although effective for PD symptoms in clinical trials, a number of potential issues may exist with use. Consideration of its future place in PD treatment in Australia may be warranted.

Prevalence of adolescent problem gambling, related harms and help-seeking behaviours among an Australian population

Epidemiological studies have consistently reported prevalence rates ranging between 0.9 and 23.5% for problem gambling among young people. With such a large range reported in the literature, it is clear that more research in this area would be of value. The current study investigated the prevalence rate of adolescent gambling and problem gambling and explored types of harm-related and help-seeking behaviours associated with gambling specific to this population in an Australian setting. A self-administered battery of questionnaires was distributed to 252 students aged 12-18 years, attending four private schools in the Eastern suburbs of Sydney, Australia. The battery included a self-administered socio-gambling demographic questionnaire, the Diagnostic and Statistical Manual Fourth Edition Multiple Response Juvenile (DSM-IV-MR-J) diagnostic instrument to assess problem gambling status, the Gambling Attitudes Scale, and questionnaires using a Likert scale to measure gambling-related harms and help-seeking behaviours. The prevalence rate among this group was found to be 6.7%. The study found further support for previous findings suggesting that a significant proportion of young people meet criteria for problem gambling, that males are at-risk and that few adolescents are able to recognise when gambling is problematic or access mental health professionals for assistance.

Adolescent gambling: a review of an emerging field of research

PURPOSE

The purpose of this review was to summarize the research on adolescent gambling with implications for research and prevention or intervention.

METHOD

The methodology involved a comprehensive and systematic search of "adolescent or youth gambling" in three diverse electronic databases (MedlineAdvanced, PsycINFO, and Sociological Abstracts) and three peer-reviewed journals (International Journal of Gambling Studies, International Journal of Mental Health and Addiction, and Journal of Gambling Issues).

RESULTS

The search resulted in 137 articles (1985-2010) focusing on gambling among youth aged between 9 and 21 years: 103 quantitative, 8 qualitative, and 26 non-empirical. The study of adolescent gambling can be summarized as follows: (a) it is conducted by a relatively small group of researchers in Britain, Canada, and the United States; (b) it is primarily prevalence-focused, quantitative, descriptive, school-based, and atheoretical; (c) it has most often been published in the Journal of Gambling Studies; (d) it is most often examined in relation to alcohol use; (e) it has relatively few valid and reliable screening instruments that are developmentally appropriate for adolescents, and (f) it lacks racially diverse samples.

CONCLUSION

Four recommendations are presented for both research and prevention or intervention which are as follows: (1) to provide greater attention to the development and validation of survey instruments or diagnostic criteria to assess adolescent problem gambling; (2) to begin to develop and test more gambling prevention or intervention strategies; (3) to not only examine the co-morbidity of gambling and alcohol abuse, but also include other behaviors such as sexual activity; and (4) to pay greater attention to racial and ethnic differences in the study of adolescent gambling.

[Problem and pathological gambling. Epidemiology and prevention]

With the expansion of the German gambling market, questions emerge concerning the magnitude of gambling-related problems in the general population and the effectiveness of preventive measures. Current prevalence rates of problem and pathological gambling range from 0.29-0.64% and 0.19-0.56%, respectively. In an international comparison, which is complicated by different methodological approaches of the primary studies, the rates fall at the lower end of the spectrum. In general, an increasing availability of gambling is connected with rising consumption among the population as well as--at least temporarily--with a growing number of gambling addicts. Whether the prevalence rate stabilizes at a certain level or even leads to a decrease after a gradual social adaption needs to be empirically evaluated. From the public health perspective, a gambling market that is strictly regulated by a state monopoly should be established to prevent targeted stimulation of demand and to implement effective safeguards. A preliminary evaluation of prevention measures can only be based on limited findings and, therefore, also has to focus on evidence on other harmful products such as alcohol and tobacco. For the sector of amusement with prize machines, direct interventions into structural characteristics and availability are recommended.